With the rising cost of medical expenses, dangerous side effects from medications, and often-ineffective outcomes from conventional treatment, both healthcare providers and patients are seeking alternatives for health promotion, disease prevention and treatments. Patients and healthcare providers are integrating complementary and alternative medicine (CAM) healthcare practices to support the human body’s natural healing capabilities into the overall medical treatment plan. Many hospitals, managed care plans, and conventional practitioners are now incorporating CAM therapies into their practices, and schools of medicine and pharmacy are beginning to teach CAM.¹ Patients report that they believe CAM will improve their health when used in combination with conventional medical treatments. And when conventional medicine has no answers, patients turn to CAM for new options. As conventional medical practitioners become more comfortable with CAM, they often refer patients to selected CAM providers.²

Use and Popularity

It’s intriguing that in the U.S., practices that focus on the patient as a whole being (integrating mind, body and spirit) are considered alternative therapies when such practices have been used among numerous civilizations and cultures for centuries. The term complementary medicine refers to health practices that are used in addition to conventional medicine (i.e., allopathic or Western medicine). Alternative methods are those practices used instead of conventional treatments. Integrative medicine combines conventional and CAM treatments for which there’s evidence of safety and effectiveness.³

The National Center for Complementary and Alternative Medicine (NCCAM) has divided CAM into five main domains — whole medical systems, mind-body medicine, biologically based therapies, manipulative and body-based practices, and movement and energy therapies. In the first national survey in 1990 of CAM use, 34% of Americans surveyed had used at least one complementary therapy during the past year, most often for a chronic illness, and 72% of CAM therapy users didn’t inform their primary care provider of the use.¹

Recent data from the 2007 National Health Interview Survey showed that approximately 38% (about 4 in 10) of American adults, and 12% (about 1 in 9) of children, use some form of CAM.⁴ People of all backgrounds use CAM; however, CAM use among adults is greater among women and those with higher levels of education and higher incomes.⁴ Although people use CAM for an array of diseases and conditions, they are most likely to use CAM for musculoskeletal problems such as back, neck or joint pain.⁵ Trends also reveal there has been significant increases in the use of specific CAM therapies — deep breathing, meditation, massage therapy and yoga. Americans spend nearly $34 billion out-of-pocket on CAM products and practices annually.⁶

Challenges with Supporting Research

Despite the popularity of complementary therapies, researchers have difficulty documenting the efficacy of CAM use because of unique characteristics that do not lend themselves to traditional, Western research. For example, these therapies are not aimed at a single pathologic process, they don’t focus on average responses, and they place more emphasis on the individual’s validation of treatment effectiveness.⁷ Many complementary therapies are tailored to the individual. For instance, there are no standard protocols for many homeopathic remedies, guided imagery and self-hypnosis treatments. In addition, not many complementary practitioners in the U.S. are well-versed in traditional, scientifically based research methods.¹ 

Western researchers’ usual methods of validating techniques are biased toward quantifiable, objective measures that overlook the sometimes subtle changes that can be verified only by the subjective response of the benefactors.⁷ Most funding sources don’t support complementary research, which restricts studies to small-scale trials that often lack statistical significance.¹ Entrepreneurial companies that have the resources to study complementary methods also have little incentive for providing funds for studies that will not result in profit-generating products.^7,8 Entrepreneurial companies are beginning to study the efficacy and use of complementary methods as their sales increase; however, professional research methodology is still lacking.

Are You Ready?

Because of consumers’ heightened interest in complementary treatments and their widening use, anecdotal efficacy, and growing supportive research evidence, allied and medical schools across the country now offer complementary healthcare courses.^1,9 Hospitals are including CAM departments. Therapists can expect questions from their patients about these complementary therapies, so they need to be informed and comfortable enough to discuss these unique approaches. In fact, as more complementary practices become integrated with allopathic and traditional procedures, therapists must learn to provide effective education as well as complementary treatments.^9,10

Complementary Therapies to Consider

Out of hundreds of complementary therapies, here are 10 that therapists can integrate into their practice with appropriate training.

Acupressure, dating back 5,000 years, is based on the concept of chi (sometimes spelled qi and pronounced “chee”), which is known as the essential life force. Chi is believed to flow through the body like blood or nerve impulses, circulating through invisible passageways known as meridians. According to this theory, when chi is balanced and evenly flowing, health ensues. When chi is stagnant, unbalanced, or overstimulated, illness occurs. Practitioners use finger pressure at points (acupoints) on the skin to access and guide the flow of chi. Once balance is restored by pressing the appropriate point, self-healing capacities are believed to take over.

Four major systems of acupressure — shiatsu, tsubo, jin shin jyutsu, and jin shin do — use different amounts of pressure, lengths of application, and acupoints. Acupressure is used to treat just about everything from allergies, the common cold, and headaches, to sport injuries and toothaches. Acupressure may also hasten recuperation from strokes and surgery. At some hospitals, practitioners use elastic acupressure wristbands, specially designed to relieve motion sickness and to quell anesthesia-induced nausea.¹¹

Aromatherapy uses essential plant oils to promote well-being. Its use dates back to 40,000 B.C. to the Australian aborigines. By the Middle Ages many people recognized the antiseptic and bactericidal properties of certain oils and attributed their positive effect on the immune system to natural elements within the oils. Today, many household cleaning and disinfecting products use aromatherapy scents, such as pine, citrus, tea tree or eucalyptus oils. Eucalyptus is also found in medicinal inhalations and liniments, and lavender and tea tree oils are added to antiseptic creams.

Research through liquid gas chromatography has identified many of the chemical components of essential oils, including alcohols, esters, ketones, oxides, aldehydes, coumarins, lactones, terpenes and phenols. Some scientists hypothesize that inhaled essential oil particles are picked up by tiny cilia located at the roof of the nose. A message about the essential oil odor is then transported to the brain, where the limbic system translates the communication and influences metabolic, stress, and emotional and hormonal responses.

Aromatic oils are used to treat a variety of physical conditions. Practitioners in the United Kingdom and Australia use aromatherapy in a wide variety of treatment settings, and practitioners in the U.S. can now take certificate programs in aromatherapy, which have been endorsed by the American Holistic Nurses Association. Chamomile, lavender, marjoram and ylang-ylang are hypnotics used to induce calm and restful sleep. Bergamot, frankincense, sandalwood, rose otto, geranium, orange or patchouli evoke a calming and sedative effect on the nervous system. Blends of essential oils can create a state of relaxation.

Except for lavender, which doesn’t irritate the skin, essential oils are diluted in a carrier oil. The patient’s verbal and nonverbal response or a patch test may be the best indicators of whether an individual can comfortably use a specific oil or blend. Oils can be inhaled via fragrancers similar to vaporizers and diffusers or applied topically during massage. In shared hospital rooms, oils for one individual can be placed on a handkerchief, tissue, or pillow, or in a vaporizing disc that is worn as a necklace. In private rooms, a few drops of oil can be placed in a light bulb ring burner or in a diffuser. In pregnancy, many oils are contraindicated due to toxic risk; therefore, pregnant women should discuss use of aromatherapy with their primary care provider, certified nurse-midwife or obstetrician and should be referred to a certified aromatherapist.¹²

Feng shui (pronounced fung shway), a Chinese term that means “wind and water,” is the art of placement. Objects are positioned in the environment to induce harmony with chi. This practice predates Confucianism and Taoism and has been in use for more than 3,000 years in China. Feng shui practitioners translated the language of mountains, valleys, and meadows so that local villagers could strategically place their habitats above flood plains, below strong winds, and safely in the embrace of land blessed with harmonious chi. A harmonious plot of land was shaped like an armchair, surrounded and protected in back and on both sides by mountains, hills, or a forest. The preferred land then descended to a lower level where a pond, stream, river or lake was located.

Practitioners used every physical feature from dead trees and animal bones to vibrant foliage and meandering streams to access the quality of the surrounding chi. One tenet of feng shui theory is that everything is alive and able to carry chi, or energy which vibrates at the cellular level. Items that bring unhappy memories are sold, given away, or thrown out. Another tenet is that chi connects every physical thing, creating an interconnected web of life. Thus, the chaotic chi in a crowded hospital room can ripple throughout the rest of the unit and have a negative effect on the whole hospital. Likewise, the soothing, nurturing chi generated by a beautiful entrance to a unit can pulse through the whole environment, creating a vibrant positivity. A joyful memory can be evoked by a treasured item, empowering it with vital chi that is re-experienced. By providing patients with a sniff of a remembered odor, the calming and rhythmic sound of a seashell, or a picture of a loved one, chi can be enhanced.

Feng shui tries to strike a balance between the two opposing life forces in the universe — yin (dark, wet, round, earthy, or cool) and yang (light, hot, straight, hard, angular, or dry). To balance a yang room, therapists can add a soft blanket, or a dark, rich-colored round pillow. When a room has no windows, it may feel devoid of chi. Therapists could add a mirror, a soft light, or a bright-colored or natural object to help attract more chi. Application of such ancient Asian theory was even practiced by Florence Nightingale, whose basic theories of nursing care focused on manipulation of the environment to enhance a patient’s own ability to heal within. Placing an inviting banner, logo, or brightly colored object at the entrance to a unit or clinic can have the effect of friendly hands beckoning families of patients to enter and patients to heal. A simple practice such as keeping a drain closed and the toilet seat down in a patient’s room can keep vital chi flowing, rather than being drawn down into the openings.^13,14 Such simple actions demonstrate that applying traditional Chinese medicine isn’t mysterious or difficult.

Guided imagery uses consciously chosen positive and healing images along with deep relaxation to reduce or manage stressors, prevent illness, and help people deal with the effects of disease. It can also be used to change negative emotions into positive ones and to enhance problem-solving. Images use all the senses — visual, aural, olfactory, gustatory and tactile. In inducing imagery, a therapist asks a patient to imagine seeing, hearing, smelling, tasting, and/or touching something in the image.¹⁵ Positron emission tomography (PET) has demonstrated that the same parts of the cerebral cortex are activated whether imagining something or actually experiencing it.¹⁶

Guided imagery has also been successfully used to relieve chronic pain and nausea and vomiting associated with chemotherapy, reduce allergic responses, lower blood pressure and control irregular heartbeat, relieve distressing gastrointestinal symptoms, and generally contribute to patients’ well-being.¹⁵ Studies confirm a positive effect upon the immune system.^16,17 A certificate program for practitioners is offered with endorsement by the American Holistic Nurses Association.⁹

Hypnosis is a relaxed, yet heightened state of awareness during which individuals are more open to suggestion. Relaxation therapy generally precedes hypnosis to prepare the person. Most people have experienced a trance state at one time or another. Daydreaming or concentrating intently on a book, movie, television program, or work project can bring on a hypnotic state.

All hypnosis is really self-hypnosis because no one will accept a suggestion unless he or she is willing. The self is always in control. Suggestions are most effective when positively phrased. Some people respond best to permissive suggestions, such as “I can feel more relaxed and refreshed,” while others respond best to commands, such as “I will feel more relaxed and refreshed.”

With training, therapists can use hypnosis to help both themselves and patients reduce stress and change behaviors related to smoking, drinking, overeating, or taking harmful drugs. Hypnosis can also be used to treat destructive anger, timidity, anxiety, allergies, itching, asthma and pain.¹⁸

Massage encompasses several methods of hands-on healing. For example, the simple backrub traditionally provided by therapists is a method of massage that enhances circulation, induces rest and relaxation, and provides healing touch. Ironically, the backrub — initially taught as a basic skill — has been phased out of standard care in many settings, just as the public is requesting massage therapy.¹⁹ In many countries, massage therapists work alongside physicians as partners in a healthcare team covered by national health insurance.

Traditional European massage includes the soft tissue manipulation techniques of effleurage (stroking), petrissage (kneading), vibration, and tapotement (tapping). Swedish massage uses a system of long, gliding strokes, friction techniques, and kneading of the more superficial layers of muscle. Esalen massage is slower, rhythmic, and hypnotic, focusing on the whole mind and body. Neuromuscular massage is a form of deep massage, often used for pain control. Concentrated finger pressure is applied to individual muscles, enhancing blood flow, releasing trigger points that cause pain, and loosening knots of muscle tension. Deep tissue massage uses slow strokes, direct pressure, or friction with movement directed across the grain of the muscles. Fingers, thumbs, or elbows can be applied, often focusing on one problem pain area. Sports massage uses portions of other types of massage as part of an athlete’s training regimen and injury healing approach. Manual lymph drainage massage uses light, rhythmic strokes to improve poor lymph flow, such as edema.¹⁹

Structural massage, known as bodywork, organizes and integrates the body in relationship to gravity through manipulating soft tissues and/or correcting inefficient patterns of movement. Structural, functional, or movement approaches to bodywork include Rolfing, Hellerwork, Rosen method, Trager, Feldenkrais, Alexander technique, and Ortho-Bionomy. In craniosacral therapy, the practitioner applies very light corrective pressure to the head, spinal column, and sacrum to re-establish efficient functioning of the entire nervous system.¹⁹ For visualization of these manipulation styles, type in these massage methods on your Internet search engine.

Massage has been shown to enhance the body’s ability to control pain naturally by stimulating the production of endorphins and other pain-controlling chemicals. In controlled studies, massage has produced relaxation in elderly participants, reduced traumatically induced spinal pain, controlled lymphedema from radical mastectomy, diminished pain and disability from inflammatory bowel disease, helped premature infants gain weight and leave the hospital sooner, increased natural killer cells in patients with HIV, and reduced depression.^{20, 21, 22 (Level B)}

Meditation can be defined as the intentional self-regulation of attention, a systematic focus on particular aspects of the inner or outer experience.²³ Two basic forms are concentration and mindfulness. Concentration, usually done with the eyes closed, focuses on a single thought, allowing other intruding ideas to float past. A mantra — a special word or phrase — can help some people meditate, while others find counting breaths or steps when walking to be just as effective. Anything that focuses and quiets the mind can work, including breathing or chanting.²³ One of the most famous and most studied forms of meditation is transcendental meditation, which employs a Buddhist technique known as “mindfulness” to help a person focus on the present moment.

Meditation has successfully countered chronic pain, hypertension, stress, panic disorders, headaches, and respiratory problems. It’s recommended by proponents for the reduction of stress and anxiety and the treatment of high cholesterol and substance abuse. Studies also confirm alterations in brain and immune function produced by mindful mediation.^{24 (Level A)} Advocates claim that meditation can enhance wellness and expand awareness.^{23, 25 (Level B), 26, 27} Therapists are increasingly using this modality with their patients, although a supporting research base is sparse.²⁷

Reflexology uses deep massage on identified points on the foot or hand to scan and rebalance body parts that correspond with each point. For example, reflexology points on the feet are arranged so that the big toe represents the head. The practice has roots in ancient China and Egypt. William H. Fitzgerald, an American physician who worked with European reflexologists, introduced the practice to the U.S. in the early 20th century as “zone therapy.” By manipulating a particular zone on the foot, practitioners claim to affect corresponding organs. Therapists in many settings have used foot massage to relax and promote comfort, and it can be particularly useful for elders with dementia.

Practitioners have treated such ailments as anemia, arthritis and back problems, carpal tunnel syndrome, gout, high blood pressure, motion sickness, thyroid problems, and headaches. One controlled clinical study of 38 women with premenstrual syndrome showed a significantly greater reduction in symptoms for the reflexology-treated group.^{28,29 (Level A)}

Relaxation therapy is a structured way of releasing muscle tension by concentrating on body parts. One form, called progressive muscle relaxation (PMR), was introduced by Edmund Jacobson, MD, in 1938. In PMR, successive muscle groups are progressively tensed and relaxed. With continued practice, subjects learn to sense muscle tension without having to progress through the PMR relaxation. Subsequent studies have supported Jacobson’s early claims that PMR can reduce oxygen consumption, metabolic rate, muscle tension, respiratory rate, premature ventricular contractions, and systolic and diastolic blood pressure, while increasing alpha brain waves.^{30, 31 (Level B), 32 (Level B), 33, 34 (Level B), 35 (Level A)}

Therapists can use other forms of relaxation therapy that use a focus word, deep breathing, and/or relaxing imagery. For example, patients may be asked to repeat the words “peace” or “love,” or a short prayer, or picture themselves in a comfortable and safe place where they feel relaxed. Another form of relaxation called autogenics combines relaxation with self-hypnosis and guided imagery. The procedure involves the repetition of meaningful phrases, such as “It breathes me,” “My forehead is cool,” or “My legs are heavy” while focusing on a sense of heaviness and warmth in the limbs or other body parts and breathing calmly.¹⁴

Therapeutic touch is a contemporary interpretation of several ancient healing traditions found in many cultures throughout history. The practice includes balancing energy by entering into a relaxed, meditative state called “centering,” then invoking an intention to heal, and moving the hands from the head to the feet several inches from the skin.¹⁴ Therapeutic touch includes Reiki, Pranic Healing, and therapeutic touch, developed by Delores Kreiger, RN, PhD, a nursing professor at New York University, and Dora Kunz, a natural healer. The practitioner serves as a conduit for universal energy working with the patient’s energy field. The method is currently taught in more than 80 universities and 30 countries.

The results of many studies of therapeutic touch since the 1970s have been mixed, often due to the nature of the research design. More recent studies have used randomized designs. A single-blinded randomized study of therapeutic touch for osteoarthritis of the knee in 25 individuals found significant improvement in function and pain for participants receiving treatment.^{36 (Level A)} Another research team examined the effect of therapeutic touch in burn patients and found that those who received therapeutic touch reported greater reduction in pain and anxiety than those in a control group without the treatment.^{37 (Level A)} Research continues to examine and validate the positive effects of therapeutic touch upon patients receiving chemotherapy and pain management interventions.^{38 (Level A)}

With the rise of consumer interest in complementary and alternative therapies, therapists must be able to answer questions about their use. These approaches may require a re-evaluation of values and beliefs because complementary modalities are based on a health and wellness paradigm, in contrast to the traditional medical model, which is based on an illness and recovery paradigm. An increasing number of allied and medical schools are providing courses on these methods, and the integration of complementary with conventional therapies is becoming a common practice. Additional continuing education about complementary procedures can prepare therapists to integrate them into practice. As patient advocates and often the first resource for many people seeking medical information, therapists need to provide accurate information and helpful direction to evaluate complementary and alternative therapies.

Resources

• American Association of Acupuncture and Oriental Medicine www.aaaomonline.org
• American Holistic Nurses Association www.ahna.org
• American Holistic Nurses’ Certification Corporation www.ahncc.org
• National Association for Holistic Aromatherapy www.naha.org
• National Center for Complementary and Alternative Medicine www.nccam.nih.gov

Gannett Education guarantees the content of this educational activity is free from bias.

The publication of this module does not constitute Gannett Education’s endorsement of the complementary therapies presented here.